Ateneo de Zamboanga University College of Nursing

NUSING SKILLS OUTPUT (NSO) Report No. _4_ THORACOTOMY TUBE CARE I. DESCRIPTION: Tube thoracostomy is the insertion of a tube (chest tube) into the pleural cavity to drain air, blood, bile, pus, or other fluids. Whether the accumulation is the result of rapid traumatic filling or insidious malignant seepage, placement of a chest tube allows for continuous, large volume drainage until the underlying pathology can be more formally addressed. The list of specific treatable etiologies is extensive, but without intervention, patients are at great risk for major morbidity or mortality. II. MATERIALS/ EQUIPMENT NEEDED: Skin preparation proviodine Heavy Mayo scissors Scalpel - #10 blade Forceps Long needle holders Finochietto retractor Lung retractor Vascular clamps Prolene vascular sutures Protective goggles / clothing

III. PROCEDURE

Confirm diagnosis of a lung or chest disease Repair the heart or the vessels of the lung and heart Treat windpipe disorders Remove a portion of the lung or the entire lung Treat throat disorders Reinflate lung tissue that has collapsed due to disease or trauma Remove pus from the chest Remove blood clots from the chest

IV. DIAGRAM/ ILLUSTRATIONS:

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V. NURSING RESPONSIBILITIES: 1. BEFORE PROCEDURE Explain the procedure to the patient. Obtain and record vital signs. Assemble the drainage system. Set up and test the suction apparatus if one is ordered. Screen the patient and remove pajama coat to expose the chest. The insertion site will depend upon the presence of air or fluid. Position the patient as directed by the physician.

2. DURING PROCEDURE Set up the thoracotomy tray on the instrument table, using sterile technique. Using sterile technique, place other supplies on the sterile field. Assist the physician with the skin prep and administration of local anesthetic as for thoracentesis. Assist the physician with tube insertion, as directed. There are varying methods of introducing a tube into the pleural space. The method used depends upon the size of the tube to be inserted, the equipment available, and the physician's preference. The physician connects the patient's chest tube and the drainage tubing, checks the entire system to verify all connections, and tapes the connections to ensure an airtight system. He will then unclamp the chest tube. The clamps are never removed until the drainage system is airtight and ready to function. The chest tube is normally sutured in place and covered with a sterile dressing. Arrange for a follow-up chest X-ray, if ordered

3. AFTER PROCEDURE Remove equipment from bedside and care for properly. Observe patient for respiratory difficulty. Continue to observe the drainage system for proper function. Tape the padded hemostats and a package of sterile vaseline gauze to the head of the patient's bed. This equipment must be available for emergency use should the chest tube become dislodged or the drainage system opened. Record the procedure in the Nursing Notes. Note the patient's tolerance to the procedure.

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Reference: http://emedicine.medscape.com/article/80678-overview#a09 http://nursing411.org/Courses/MD0917_Nursing_care_cardio_resp/224_Nursing_Care_related_to_the_cardiorespiratory_system.html

JULY 11, 12, 13, 2013 Date EIREES JOY A. MENDOZA BSN III-D

MS. MARIA FE AGUILAR Clinical Instructors Initials

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